Center for Primary Care, Harvard Medical School, Boston, Massachusetts.
Center for Primary Care, Harvard Medical School, Boston, Massachusetts
Ann Fam Med. 2020 Nov;18(6):535-544. doi: 10.1370/afm.2587.
We sought to determine the financial impact to primary care practices of alternative strategies for offering buprenorphine-based treatment for opioid use disorder.
We interviewed 20 practice managers and identified 4 approaches to delivering buprenorphine-based treatment via primary care practice that differed in physician and nurse responsibilities. We used a microsimulation model to estimate how practice variations in patient type, payer, revenue, and cost across primary care practices nationwide would affect cost and revenue implications for each approach for the following types of practices: federally qualified health centers (FQHCs), non-FQHCs in urban high-poverty areas, non-FQHCs in rural high-poverty areas, and practices outside of high-poverty areas.
The 4 approaches to buprenorphine-based treatment included physician-led visits with nurse-led logistical support; nurse-led visits with physician oversight; shared visits; and solo prescribing by physician alone. Net practice revenues would be expected to increase after introduction of any of the 4 approaches by $18,000 to $70,000 per full-time physician in the first year across practice type. Yet physician-led visits and shared medical appointments, both of which relied on nurse care managers, consistently produced the greatest net revenues ($29,000-$70,000 per physician in the first year). To ensure positive net revenues with any approach, providers would need to maintain at least 9 patients in treatment, with a no-show rate of <34%.
Using a simulation model, we estimate that many types of primary care practices could financially sustain buprenorphine-based treatment if demand and no-show rate requirements are met, but a nurse care manager-based approach might be the most sustainable.
我们旨在确定为阿片类药物使用障碍提供丁丙诺啡为基础的治疗的替代策略对初级保健实践的经济影响。
我们采访了 20 名实践经理，并确定了通过初级保健实践提供丁丙诺啡为基础的治疗的 4 种方法，这些方法在医生和护士的职责上有所不同。我们使用微观模拟模型来估计全国范围内初级保健实践中患者类型、支付方、收入和成本的变化如何影响每种方法的成本和收入影响，以下是 4 种方法：合格的联邦健康中心 (FQHC)、城市高贫困地区的非 FQHC、农村高贫困地区的非 FQHC 和高贫困地区以外的实践。
丁丙诺啡为基础的治疗的 4 种方法包括医生主导的就诊，护士主导的后勤支持；护士主导的就诊，医生监督；共享就诊；以及医生单独开具处方。在引入任何一种方法的第一年，全职医生的净实践收入预计将增加 18000 至 70000 美元，这在实践类型中都是如此。然而，医生主导的就诊和共享医疗预约都依赖于护士护理经理，这两种方法始终产生最大的净收入（第一年每位医生 29000 至 70000 美元）。为了确保任何方法都有正的净收入，提供者需要至少维持 9 名患者的治疗，并且缺诊率<34%。
使用模拟模型，我们估计如果需求和缺诊率要求得到满足，许多类型的初级保健实践都可以在财务上维持丁丙诺啡为基础的治疗，但基于护士护理经理的方法可能更可持续。
